CAJ | 학술논문

目的：比较椎动脉起始部狭窄患者支架置入与单纯药物治疗的疗效。方法回顾性分析2011年1月至2013年1月82例椎动脉起始部中重度狭窄（狭窄率＞50％）患者的临床资料，按治疗方法的不同分为支架＋药物组40例和药物组42例。记录患者治疗后1年DSA或CT血管成像复查时狭窄血管的狭窄程度、再狭窄率、脑缺血事件发生率、美国国立卫生研究院卒中量表（NIHSS），并进行综合分析。结果（1）对40例支架置入患者共置入44枚支架，其中1例因狭窄部斑块较硬，虽经2次球囊后扩张，仍残余狭窄60％；围手术期间无严重并发症发生，手术成功率为97.5％（39／40）。支架置入1年时，支架＋药物组患者椎动脉起始部的狭窄率显著改善，由（73±13）％降至中位数11％（8％，50％）（P ＜0．01）。（2）支架置入后1年，支架＋药物组有11例（27.5％）患者出现支架内狭窄，其中有2例患者同时存在支架断裂；药物组有4例（9.5％）患者椎动脉完全闭塞，但仅2例患者出现相应的临床症状。（3）支架＋药物组患者与药物组相比，治疗后两组NIHSS评分的差异无统计学意义（Z＝1．678，P＝0.093）。支架＋药物组患者总的缺血性事件为7例（17.5％），与单纯药物组的16例（38.1％）比较，差异有统计学意义（χ2＝4．306，P＝0.038）。结论支架置入治疗椎动脉起始部狭窄患者安全、有效，可以明显改善椎动脉狭窄，并且对预防后循环缺血性事件优于单纯药物治疗，但椎动脉起始部支架置入较高的再狭窄率仍是亟待解决的重要问题。
목적：비교추동맥기시부협착환자지가치입여단순약물치료적료효。방법회고성분석2011년1월지2013년1월82례추동맥기시부중중도협착（협착솔＞50％）환자적림상자료，안치료방법적불동분위지가＋약물조40례화약물조42례。기록환자치료후1년DSA혹CT혈관성상복사시협착혈관적협착정도、재협착솔、뇌결혈사건발생솔、미국국립위생연구원졸중량표（NIHSS），병진행종합분석。결과（1）대40례지가치입환자공치입44매지가，기중1례인협착부반괴교경，수경2차구낭후확장，잉잔여협착60％；위수술기간무엄중병발증발생，수술성공솔위97.5％（39／40）。지가치입1년시，지가＋약물조환자추동맥기시부적협착솔현저개선，유（73±13）％강지중위수11％（8％，50％）（P ＜0．01）。（2）지가치입후1년，지가＋약물조유11례（27.5％）환자출현지가내협착，기중유2례환자동시존재지가단렬；약물조유4례（9.5％）환자추동맥완전폐새，단부2례환자출현상응적림상증상。（3）지가＋약물조환자여약물조상비，치료후량조NIHSS평분적차이무통계학의의（Z＝1．678，P＝0.093）。지가＋약물조환자총적결혈성사건위7례（17.5％），여단순약물조적16례（38.1％）비교，차이유통계학의의（χ2＝4．306，P＝0.038）。결론지가치입치료추동맥기시부협착환자안전、유효，가이명현개선추동맥협착，병차대예방후순배결혈성사건우우단순약물치료，단추동맥기시부지가치입교고적재협착솔잉시극대해결적중요문제。
Objective Tocomparetheefficacybetweenstentingandmedicationinpatientswith vertebralarteryoriginstenosis.Methods Theclinicaldataof82patientswithmoderatetoseverevertebral artery origin stenosis (stenosis rate >50%)from January 2011 to January 2013 were analyzed retrospectively. They were divided into either a stent+medication group (n=40)or a medication group (n=42)according to the different treatment methods. The degree of vascular stenosis,restenosis rate,incidence of cerebral ischemic events,and National Institutes of Health Stroke Scale (NIHSS)of the patients for DSA reexamination at one year were documented,and comprehensive analysis were conducted. Results (1 )44 stents were implanted in 40 patients,1 of the patients still had residual stenosis of 60% because of the stenosis plaque was harder despite twice balloon dilations. No serious perioperative complications occurred. The success rate of the operation was 97. 5%. The vascular stenosis rate of vertebral artery origins in patients of the stent+medication group was improved significantly,and decreased from 73 ± 13% to median 11%(8%,50%)at one year after stenting. (2)After 1 year,11 patients (27. 5%)had in-stent restenosis in the stent +medication group,including 2 patients (5%)had stent fracture at the same time. Four patients (9. 5%)in the medication group had complete occlusion of vertebral artery,but only 2 had corresponding clinical symptoms. (3)There was no significant difference in the NIHSS scores after the treatment between the stent+medication group and the medication group (Z=1. 678,P=0. 093). The total ischemic events in patients of the stent+medication group was 7 (17. 5%),compared with the incidence of ischemic events in 16 patients (38. 1%)in the medication group,there was significant difference (χ2 =4. 306, P=0.038).Conclusion Stentingissafeandeffectiveforpatientswithvertebralarteryoriginstenosis.It may significantly improve vertebral stenosis,and it is better than medication alone for preventing the occurrence alone of the posterior circulation ischemic events,however,the high in-stent restenosis rate for vertebral artery origin stenosis is still an important problem to be solved.